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Junjing Su, Charmilie C Logan, Alun D Hughes, Kim H Parker, Niti M Dhutia, Carl Christian Danielsen, Ulf Simonsen
Arterial stiffness and wave reflection are important components of the ventricular afterload. Therefore, we aimed to assess the arterial wave characteristics and mechanical properties of the proximal pulmonary arteries (PAs) in the hypoxic pulmonary hypertensive rat model. After 21 days in normoxic or hypoxic chambers (24 animals in each group), the animals underwent transthoracic echocardiography and pulmonary artery catheterization with a dual-tipped pressure and Doppler flow sensor wire. Wave intensity analysis (WIA) was performed...
March 16, 2018: American Journal of Physiology. Heart and Circulatory Physiology
Julio Sandoval
Despite advances in drug therapy, pulmonary hypertension-particularly arterial hypertension (PAH)-remains a fatal disease. Untreatable right heart failure (RHF) from PAH eventually ensues and remains a significant cause of death in these patients. Lowering pulmonary input impedance with different PAH-specific drugs is the obvious therapeutic target in RHF due to chronically increased afterload. However, potential clinical gain can also be expected from attempts to unload the right heart and increase systemic output...
March 12, 2018: Revista Española de Cardiología
Thenappan Thenappan, Mark L Ormiston, John J Ryan, Stephen L Archer
Pulmonary hypertension is defined as a resting mean pulmonary artery pressure of 25 mm Hg or above. This review deals with pulmonary arterial hypertension (PAH), a type of pulmonary hypertension that primarily affects the pulmonary vasculature. In PAH, the pulmonary vasculature is dynamically obstructed by vasoconstriction, structurally obstructed by adverse vascular remodeling, and pathologically non-compliant as a result of vascular fibrosis and stiffening. Many cell types are abnormal in PAH, including vascular cells (endothelial cells, smooth muscle cells, and fibroblasts) and inflammatory cells...
March 14, 2018: BMJ: British Medical Journal
Sigrid Baumgartner, Monika Olischar, Martin Wald, Tobias Werther, Angelika Berger, Thomas Waldhör, Georg Fischer, Ulrike Salzer-Muhar
BACKGROUND: Postnatally, the immature left ventricle (LV) is subjected to high systemic afterload. Hypothesizing that LV pumping would change during transition-adaptation we analyzed the LV in preterm infants (GA≤32+6), clinically stable or with a hemodynamically significant PDA (hPDA) by applying a pump model. METHODS: Pumping was characterized by EA (effective arterial elastance, reflecting afterload), EES (endsystolic LV elastance, reflecting contractility), EA /EES -coupling ratios, descriptive EA :EES relations and EA /EES -graphs...
March 14, 2018: Pediatric Research
Anna Cavigelli-Brunner, Maja I Hug, Hitendu Dave, Oskar Baenziger, Christoph Buerki, Dominique Bettex, Vincenzo Cannizzaro, Christian Balmer
OBJECTIVES: Dobutamine and milrinone are commonly used after open-heart surgery to prevent or treat low cardiac output syndrome. We sought to compare efficacy and safety of these drugs in pediatric patients. DESIGN: Prospective, single-center, double-blinded, randomized clinical pilot study. SETTING: Tertiary-care university children's hospital postoperative pediatric cardiac ICU. PATIENTS: After written consent, 50 consecutive patients (age, 0...
March 13, 2018: Pediatric Critical Care Medicine
Mohsen Bakouri
In this study, the physiological control algorithm using sliding mode control method is implemented to track the reference input signal. The controller is developed using feed-forward part, reference model, and steady-state flow estimator. The proposed control method is evaluated using a dynamic heart-pump interaction model incorporating descriptions of the cardiovascular system - rotary blood pump. The immediate response of the controller to preload as well as afterload was studied. Stability and feasibility of the control system were demonstrated through the tests...
April 2018: IET Systems Biology
Georgia Brown, Tilman Humpl
PURPOSE OF REVIEW: Pulmonary vascular disease (PVD) complicates the course of many cardiovascular, pulmonary and other systemic diseases in children. The physiological sequelae (pulmonary hypertension and elevated pulmonary vascular resistance) can overwhelm the right ventricle and lead to circulatory collapse. Despite the common end-point, the preceding pathophysiology is complex and variable and requires a tailored approach to diagnosis and management. In this article, we will review the most recent evidence and explore an approach to current controversies in the diagnosis and management of common or challenging patient subgroups...
March 9, 2018: Current Opinion in Pediatrics
Takashi Kido, Takaya Hoashi, Masataka Kitano, Masatoshi Shimada, Kenichi Kurosaki, Hatsue Ishibashi-Ueda, Hajime Ichikawa
The purpose of the study is to analyze the impact of hybrid stage 1 palliation on right ventricular myocardial pathology in hypoplastic left heart syndrome. Sufficient amount of right ventricular biopsies could be obtained from 16 of 32 patients who underwent Norwood operation between 2007 and 2013. Histopathological findings of right ventricle in patients who underwent primary Norwood operation (primary group, n = 5), patients with aortic atresia (HS1P AA group, n = 6) or aortic stenosis (HS1P AS group, n = 5) who underwent staged Norwood palliation following hybrid stage 1 palliation were compared...
March 9, 2018: Pediatric Cardiology
Dirk W Donker, Daniel Brodie, José P S Henriques, Michael Broomé
Veno-arterial extracorporeal membrane oxygenation (VA ECMO) is widely used in cardiogenic shock. It provides systemic perfusion, but left ventricular (LV) unloading is suboptimal. Using a closed-loop, real-time computer model of the human cardiovascular system, cardiogenic shock supported by peripheral VA ECMO was simulated and effects of various adjunct LV unloading interventions were quantified. After VA ECMO initiation (4 L/min) in cardiogenic shock (baseline), hemodynamics improved (mean arterial pressure (MAP) increased to 85 mmHg), while LV overload occurred (10% increase in end-diastolic volume (EDV), and 5 mmHg increase in pulmonary capillary wedge pressure (PCWP))...
March 6, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Nabham Rai, Swathi Veeroju, Yves Schymura, Wiebke Janssen, Astrid Wietelmann, Baktybek Kojonazarov, Norbert Weissmann, Johannes-Peter Stasch, Hossein Ardeschir Ghofrani, Werner Seeger, Ralph Theo Schermuly, Tatyana Novoyatleva
Pulmonary arterial hypertension (PAH) is a progressive disorder characterized by remodeling of the pulmonary vasculature and a rise in right ventricular (RV) afterload. The increased RV afterload leads to right ventricular failure (RVF) which is the reason for the high morbidity and mortality in PAH patients. The objective was to evaluate the therapeutic efficacy and antiremodeling potential of the phosphodiesterase type 5 (PDE5) inhibitor sildenafil and the soluble guanylate cyclase stimulator riociguat in a model of pressure overload RV hypertrophy induced by pulmonary artery banding (PAB)...
2018: BioMed Research International
Martin Koestenberger, Alexander Avian, Hannes Sallmon, Andreas Gamillscheg, Gernot Grangl, Stefan Kurath-Koller, Sabrina Schweintzger, Ante Burmas, Georg Hansmann
OBJECTIVE: The right ventricular outflow tract (RVOT) is pivotal for adequate RV function and known to be adversely affected by elevated pulmonary arterial pressure (PAP) in adults with pulmonary hypertension (PH). Aim of this study was to determine the effects of increased RV pressure afterload in children with PH on RVOT size, function, and flow parameters. METHODS: We conducted a transthoracic echocardiographic study in 51 children with PH (median age: 5.3 years; range 1...
March 5, 2018: Echocardiography
Masahiko Asami, Jonas Lanz, Stefan Stortecky, Lorenz Räber, Anna Franzone, Dik Heg, Lukas Hunziker, Eva Roost, George Cm Siontis, Marco Valgimigli, Stephan Windecker, Thomas Pilgrim
OBJECTIVES: This study sought to determine the impact of left ventricular (LV) diastolic dysfunction (LVDD) on clinical outcomes in patients undergoing transcatheter aortic valve replacement (TAVR). BACKGROUND: LV hypertrophy in response to afterload increase promotes the development of LVDD and represents an early stage in the progression to valvular heart failure. METHODS: In a consecutive cohort of 777 aortic stenosis patients undergoing TAVR, LVDD was categorized according to the latest guidelines...
February 24, 2018: JACC. Cardiovascular Interventions
Hongyu Jiang, Rajeev Badkul, Damodar Pokhrel
PURPOSE: As an alternative to cylindrical applicators, air-inflated balloon applicators have been introduced into high-dose-rate (HDR) vaginal cuff brachytherapy to achieve sufficient dose to the vagina mucosa as well as to spare organs at risk, mainly the rectum and bladder. Commercial treatment planning systems which employ formulae in the AAPM Task Group No. 43 (TG 43) report do not take into account tissue inhomogeneity. Consequently, the low-density air in a balloon applicator induces different doses delivered to the mucosa from planned by these planning systems...
March 1, 2018: Journal of Applied Clinical Medical Physics
Jean-Barthelemy Gnakamene, Michel E Safar, Bernard I Levy, Brigitte Escoubet
BACKGROUND: Left ventricular (LV) torsion plays a key role in cardiac efficiency. In hypertension, aortic stiffening augments cardiac afterload. However, little is known about the links between LV regional contraction and aortic stiffness. We, therefore, investigated these relationships and their contribution to LV diastolic function. METHODS AND RESULTS: The study included normotensive and hypertensive individuals with normal LV ejection. Apical, basal, and global LV rotation rate and LV global longitudinal strain were measured (2-dimensional speckle tracking echocardiography)...
February 28, 2018: Journal of the American Heart Association
Sandeep M Patel, Jerry Lipinski, Sadeer G Al-Kindi, Toral Patel, Petar Saric, Jun Li, Fahd Nadeem, Thomas Ladas, Amer Alaiti, Ann Phillips, Benjamin Medalion, Salil Deo, Yakov Elgudin, Marco A Costa, Mohammed Najeeb Osman, Guilherme F Attizzani, Guilherme H Oliveira, Basar Sareyyupoglu, Hiram G Bezerra
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been used for refractory cardiogenic shock; however, it is associated with increased left ventricular afterload. Outcomes associated with the combination of a percutaneous left ventricular assist device (Impella) and VA-ECMO remains largely unknown. We retrospectively reviewed patients treated for refractory cardiogenic shock with VA-ECMO (2014-2016). The primary outcome was all-cause mortality within 30 days of VA-ECMO implantation. Secondary outcomes included duration of support, stroke, major bleeding, hemolysis, inotropic score, and cardiac recovery...
February 27, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Jonathan R Weir-McCall, Patrick Sk Liu-Shiu-Cheong, Allan D Struthers, Brian J Lipworth, J Graeme Houston
BACKGROUND: Pulmonary pulse wave velocity (PWV) allows the non-invasive measurement of pulmonary arterial stiffening, but has not previously been assessed in COPD. The aim of the current study was to assess PWV in COPD and its association with right ventricular (RV) remodelling. METHODS: Fifty-eight participants with COPD underwent pulmonary function tests, 6-min walk test and cardiac MRI, while 21 healthy controls (HCs) underwent cardiac MRI. Thirty-two COPD patients underwent a follow-up MRI to assess for longitudinal changes in RV metrics...
February 27, 2018: European Radiology
Hany M Elrakhawy, Mohamed A Alassal, Ayman M Shaalan, Ahmed A Awad, Sameh Sayed, Mohammad M Saffan
BACKGROUND: Right ventricular (RV) dysfunction after pulmonary resection in the early postoperative period is documented by reduced RV ejection fraction and increased RV end-diastolic volume index. Supraventricular arrhythmia, particularly atrial fibrillation, is common after pulmonary resection. RV assessment can be done by non-invasive methods and/or invasive approaches such as right cardiac catheterization. Incorporation of a rapid response thermistor to pulmonary artery catheter permits continuous measurements of cardiac output, right ventricular ejection fraction, and right ventricular end-diastolic volume...
January 15, 2018: Heart Surgery Forum
Sean Collins, Jennifer Martindale
PURPOSE OF REVIEW: In spite of advances in our understanding of acute heart failure (AHF) and its different phenotypic expressions, AHF management is still centered on volume removal with intravenous diuretics. This narrative review describes the pathophysiology underlying hypertensive AHF and appraises therapies targeting these mechanisms. RECENT FINDINGS: Vascular redistribution rather than volume overload may be the primary determinant of elevated cardiac filling pressures and subsequent pulmonary congestion in patients with hypertensive AHF; in these patients, vasodilators should be the predominant treatment...
February 24, 2018: Current Hypertension Reports
Amresh Raina, Talha Meeran
PURPOSE: In patients with left-sided HF, there has been less emphasis on the pathophysiology of the RV in terms of diagnostic evaluation and treatment, versus focus on structural abnormalities of the LV. This review seeks to delineate the importance of RV dysfunction in terms of its contribution to symptomatic limitations and cardiovascular outcomes in patients with left-sided HF. RECENT FINDINGS: Recent studies have demonstrated that RV dysfunction is common in both HFpEF and HFrEF, but more pronounced in HFrEF...
February 21, 2018: Current Heart Failure Reports
Federico Pappalardo, Anna Mara Scandroglio, Azeem Latib
Extracorporeal membrane oxygenation is used for acute respiratory distress syndrome, refractory cardiogenic shock, and out-of-hospital cardiac arrest with uncertain neurological status, and, until recently, it was the only minimally invasive option to achieve biventricular support. However, extracorporeal membrane oxygenation increases left ventricular afterload and requires systemic anticoagulation, which is a major contraindication in the context of thrombolytic therapy following an ischaemic stroke. Conversely, the Impella heart pumps by design unload the ventricle and require minimal anticoagulation...
February 21, 2018: ESC Heart Failure
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